Gateway Patriot Exchange Program

Designed for students studying abroad or participants of cultural exchange programs. Coverage is designed to meet the U.S. J1 visa travel insurance requirements.

Highlights:

• Two short-term travel medical plan designs
• Coverage for students, their spouses and unmarried dependent children traveling with them
• Plan Maximums up to $500,000
• Renewable up to 48 months if minimum of three months is purchased
• Freedom to seek treatment with hospital or doctor of your choice
• Universal Rx pharmacy discount savings
• 24 hour secure access from anywhere in the world to manage your account at any time
• Student Health Center $5 co-pay per visit
• No coinsurance
• Optional add-on coverage available for high school sports, personal sports and legal assistance
• Pre-existing conditions coverage available to U.S. and non-U.S. citizens - see specific plan design for benefit information

Gateway Patriot Exchange Program Non-U.S. Highlights

Overview

Gateway Patriot Exchange Program is designed for those who are:

• Actively engaged or participating in an educational or cultural exchange program in the country of assignment.
• Traveling to a destination that is not their home country.

Obtaining coverage is as simple as:

• Filling out the Enrollment Form with the information requested.
• Mailing or faxing the above information to your independent agent or IMG.

Premium

Gateway Patriot Exchange Program Standard (Worldwide excluding USA)

The Gateway Patriot Exchange Program Standard (Worldwide excluding USA) is designed for those who are:

• Actively engaged or participating in an educational or cultural exchange program in the country of assignment.
• Traveling to a destination that is not their home country.
• All premium rates are in U.S. dollars and are effective through March 1, 2012. Rates include surplus lines tax where applicable. A dependent child is your child shown on the Application Form over 14 days and under 18 years of age, traveling with you, and for whom premium has been paid.

Basic Short-Term Travel Plan Rates

Standard Short-Term Travel Plan Rates

A long-term plan is also available. For more information, please contact your independent insurance agent or International Medical Group at 1-800-628-4664.

Benefits Basic Plan:

Benefits Standard Plan

Exclusions:

Charges for the following services, treatments and/or conditions, among others, are excluded from coverage under the Gateway Patriot Exchange Program plans.

• A Pre-existing Condition is defined as any injury, illness, sickness, disease, or other physical, medical, mental or nervous condition, disorder or ailment that, with reasonable medical certainty, existed at the time of application or at any time during the three years prior to the effective date of the insurance, whether or not previously manifested or symptomatic, diagnosed, treated, or disclosed prior to the effective date, including any subsequent, chronic or recurring complications or consequences related thereto or arising therefrom.
• Treatment or surgeries which are elective, investigational, experimental or for research purposes.
• War, military action, terrorism, political insurrection, protest, or any act thereof. The Company will not pay for a Political Evacuation if there is a travel advisory in effect on or within six (6) months prior to the Insured Person’s date of arrival in the Host Country.
• Immunizations and routine physical exams.
• Treatment of Temporomandibular Joint or dental treatment, except as expressly provided for in the certificate of insurance.
• Venereal disease, AIDS virus, AIDS related illness, ARC Syndrome, or AIDS, and the cost of testing for these conditions, and charges for treatment or surgeries which are incurred by any Insured who was HIV+ at time of enrollment into this insurance.
• Pregnancy, childbirth, birth control, artificial insemination, treatment for infertility or impotency, sterilization or reversal thereof, or abortion.
• Injury sustained while participating in amateur or professional sports or other athletic activity which is organized and/or sanctioned, or which involves regular or scheduled practices, games or competition. The following hazardous activities are excluded: racing of any kind, aviation (except when traveling as a passenger in a commercial aircraft), BMX, BASE jumping, bobsleigh, bungee jumping, canyoning, caving, high diving, hang gliding, heli-skiing, hot air ballooning, inline skating, jet skiing, kayaking, luge, motocross (moto-x), mountain biking, mountaineering, parachuting, rappelling, rock climbing, rodeo, scuba diving, ski jumping, sky diving, snow skiing, snowboarding, snowmobiling, spelunking, snorkeling, surfing, wakeboarding, water skiing, wind-surfing and whitewater rafting.
• Vision or ear tests and the provision of visual or hearing aids.
• Vocational, recreational, speech or music therapy.
• Treatment while confined primarily to receive custodial care, educational or rehabilitative care, or nursing services.
• Charges, injuries and/or illnesses resulting or arising from or occurring during the commission or continuing perpetration of a violation of law by the insured, including without limitation, the engaging in an illegal occupation or act, but excluding minor traffic violations.
• Treatment for, and injuries and/or illnesses resulting or arising from, substance abuse or drug addiction.
• Injury and/or illness resulting or arising from being under the influence of alcohol or drugs; and injury or illness resulting from operating any type of vehicle after consuming any alcohol or drugs.
• Willful self-inflicted injury or illness.
• Treatment required as a result of or arising from complications from a treatment or condition not covered under the certificate.
• Any services or supplies performed or provided by a relative of the Insured or provided at no cost to Insured.
• Treatment for mental and nervous disorders.
• Organ or tissue transplants or related services.
• Illness or injury where the trip to the host country is undertaken for treatment or advice for such illness or injury, except as expressly provided for in the certificate of insurance.
• Treatment incurred as a result of or arising from exposure to nuclear radiation, and/or radioactive material(s).
• Charges for Treatment of a Chronic Illness incurred beyond sixty (60) days from the date of initial Treatment thereof.

Gateway Patriot Exchange Program U.S. Highlights

Overview

Gateway Patriot Exchange Program is designed for those who are:

• Actively engaged or participating in an educational or cultural exchange program in the country of assignment.
• Traveling to a destination that is not their home country.

Obtaining coverage is as simple as:

• Filling out the Enrollment Form with the information requested.
• Mailing or faxing the above information to your independent agent or IMG.

Premium

Gateway Patriot Exchange Program Standard (Worldwide)

The Gateway Patriot Exchange Program Standard (Worldwide) is designed for those who are:

• Actively engaged or participating in an educational or cultural exchange program in the country of assignment.
• Traveling to a destination that is not their home country.
• All premium rates are in U.S. dollars and are effective through March 1, 2012. Rates include surplus lines tax where applicable. A dependent child is your child shown on the Application Form over 14 days and under 18 years of age, traveling with you, and for whom premium has been paid.

Basic Short-Term Travel Plan Rates

Standard Short-Term Travel Plan Rates

A long-term plan is also available. For more information, please contact your independent insurance agent or International Medical Group at 1-800-628-4664.

Benefits Basic Plan:

Benefits Standard Plan

Exclusions:

Charges for the following services, treatments and/or conditions, among others, are excluded from coverage under the Patriot Exchange Program plans.

• A Pre-existing Condition is defined as any injury, illness, sickness, disease, or other physical, medical, mental or nervous condition, disorder or ailment that, with reasonable medical certainty, existed at the time of application or at any time during the three years prior to the effective date of the insurance, whether or not previously manifested or symptomatic, diagnosed, treated, or disclosed prior to the effective date, including any subsequent, chronic or recurring complications or consequences related thereto or arising therefrom.
• Treatment or surgeries which are elective, investigational, experimental or for research purposes.
• War, military action, terrorism, political insurrection, protest, or any act thereof. The Company will not pay for a Political Evacuation if there is a travel advisory in effect on or within six (6) months prior to the Insured Person’s date of arrival in the Host Country.
• Immunizations and routine physical exams.
• Treatment of Temporomandibular Joint or dental treatment, except as expressly provided for in the certificate of insurance.
• Venereal disease, AIDS virus, AIDS related illness, ARC Syndrome, or AIDS, and the cost of testing for these conditions, and charges for treatment or surgeries which are incurred by any Insured who was HIV+ at time of enrollment into this insurance.
• Pregnancy, childbirth, birth control, artificial insemination, treatment for infertility or impotency, sterilization or reversal thereof, or abortion.
• Injury sustained while participating in amateur or professional sports or other athletic activity which is organized and/or sanctioned, or which involves regular or scheduled practices, games or competition. The following hazardous activities are excluded: racing of any kind, aviation (except when traveling as a passenger in a commercial aircraft), BMX, BASE jumping, bobsleigh, bungee jumping, canyoning, caving, high diving, hang gliding, heli-skiing, hot air ballooning, inline skating, jet skiing, kayaking, luge, motocross (moto-x), mountain biking, mountaineering, parachuting, rappelling, rock climbing, rodeo, scuba diving, ski jumping, sky diving, snow skiing, snowboarding, snowmobiling, spelunking, snorkeling, surfing, wakeboarding, water skiing, wind-surfing and whitewater rafting.
• Vision or ear tests and the provision of visual or hearing aids.
• Vocational, recreational, speech or music therapy.
• Treatment while confined primarily to receive custodial care, educational or rehabilitative care, or nursing services.
• Charges, injuries and/or illnesses resulting or arising from or occurring during the commission or continuing perpetration of a violation of law by the insured, including without limitation, the engaging in an illegal occupation or act, but excluding minor traffic violations.
• Treatment for, and injuries and/or illnesses resulting or arising from, substance abuse or drug addiction.
• Injury and/or illness resulting or arising from being under the influence of alcohol or drugs; and injury or illness resulting from operating any type of vehicle after consuming any alcohol or drugs.
• Willful self-inflicted injury or illness.
• Treatment required as a result of or arising from complications from a treatment or condition not covered under the certificate.
• Any services or supplies performed or provided by a relative of the Insured or provided at no cost to Insured.
• Treatment for mental and nervous disorders.
• Organ or tissue transplants or related services.
• Illness or injury where the trip to the host country is undertaken for treatment or advice for such illness or injury, except as expressly provided for in the certificate of insurance.
• Treatment incurred as a result of or arising from exposure to nuclear radiation, and/or radioactive material(s).
• Charges for Treatment of a Chronic Illness incurred beyond sixty (60) days from the date of initial Treatment thereof.

Gateway Patriot Exchange Program U.S. Contact Us

If you have any questions regarding IMG or the products located on this website, please contact us. We are available to provide support to our producers and prospective clients. Our contact information is below. Additionally, you may use the online inquiry form. An IMG representative will review your questions or comments, and respond in a timely manner.

International Medical Group
2960 North Meridian Street
Indianapolis, IN USA 46208-4715

Telephone: 1.317.655.4500 or 1.877.808.7434

Fax:1.317.655.4505

Email: insurance@imglobal.com

For all claims correspondence, please use the following address:

International Medical Group
Claims Department
PO Box 88500
Indianapolis, IN 46208-0500

To submit applications, underwriting information or premium, please use the following address:

International Medical Group
PO Box 88509
Indianapolis, IN 46208-0509